Essential update: WHO ranks depression as top cause of adolescent illness and disability

A new World Health Organization (WHO) report, “Health for the World’s Adolescents: A Second Chance in the Second Decade,” states that depression is the most frequent cause worldwide of illness and disability in persons aged 10-19 years, with the rate being highest in females. The report also states that up to half of all mental disorders arise by age 14 years but that they are usually not recognized. Suicide is listed as the third leading cause of death among adolescents, behind road injuries and the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS).

The following is the opinion of Dr Paul Bowden of Go Psychology (Gold Coast) commenting on Australian adolescents:

In my opinion, adolescents are under a lot of pressure in our society today. In general, families are spending less quality time together due to a range of factors including excessive working hours, broken families, and social media which is resulting in disconnections within family units and between parents and their teenagers. The pressure our society places on all of us is leading to an epidemic of people with low self worth. The reputation of adolescents has been damaged by the media who portray them as “the brats who hang around the parks and shopping centres causing trouble”.

As a society we need to respect and nurture or adolescents and realize that they are valuable members of our community who in the not too distant future will be stepping up into more prominent roles within our community.

We need to nurture our adolescents, help them to develop their areas of strength, help them develop their self worth, help them to become socially responsible people, and love them and cherish them for who they are.

We need to breed an attitude of cooperation between our adolescents rather than at attitude of competition.

If an adolescent has gone off the rails that is the fault of the adults around them in their lives, and we need to step up and help them, and direct them in the right ways, not punish them for wrongdoing.

Nevertheless, the unfortunate truth is that far too many adolescents are going to suffer clinical depression, and may even consider or attempt suicide.

Please read below so that you can become aware of the signs and symptoms to watch out for.

The above content is the opinion of Dr Paul Bowden and in no way reflects the opinions of any other professional person.

The following information is again sourced from the World Health Organisation.

Signs and symptoms of teenage depression

A major depressive episode in children and adolescents typically includes at least 5 of the following symptoms (including at least 1 of the first 2) during the same 2-week period:

Symptoms must cause significant distress or impairment of important functioning and must not be attributable to the direct action of a substance or to a medical or other psychiatric condition.

Depression may occur with or without the following:

Psychotic symptoms

Chronicity

Melancholic features

Catatonic features

Seasonality

Depression may also have atypical features, including mood reactivity and at least 2 of the following for at least 2 weeks:

Increase in appetite or significant weight gain

Increased sleep

Feelings of heaviness in arms or legs

A pattern of long-standing interpersonal rejection sensitivity that extends far beyond the mood disturbance episodes and results in significant impairment in social or occupational functioning

Medical evaluation is always indicated to rule out organic etiologies that may imitate a depressive disorder, such as the following:

Infection

Medication

Endocrine disorder

Tumor

Neurologic disorder

Treatment Approach Considerations

Current evidence-supported interventions include cognitive-behavioral psychotherapy, pharmacotherapy, or a combination of both should be offered as treatment for children and adolescents with major depressive disorder (MDD). Safety is always the first concern in the evaluation of MDD in children and adolescents. Risk assessment of patients who are depressed should be ongoing. Documentation should support clinical decision-making.

A comprehensive understanding of environmental factors including the adolescents’ home, school, and work environments should be gained and included in treatment where appropriate.

In mild cases, psychosocial interventions are often recommended as first-line treatments, whereas, in the more severe cases, medication is required.

The clinician must carefully assess the risk for suicide in any child who is depressed. If a child is preoccupied with thoughts of suicide or has definite plans, or has other significant risk factors for suicide, the patient should be hospitalized. The clinician should weigh factors such as the child’s ability to function and the stability of the family, plus any history of previous suicide attempts, when determining whether or not a child or adolescent should be hospitalized.